Urinary tract infections and kidney stones in pregnancy Quiz: Ace Your Exams
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A 24-year-old primigravid woman presents to an urgent care clinic at 29 weeks’ gestation with intense flank pain radiating to the groin. The pain woke her from sleep and comes in waves lasting about 30 minutes each. Yesterday there were no symptoms, although she spent the day outside in the summer heat. There is no associated fever, chills, vaginal bleeding, cramping, or loss of fluid. The patient is normally healthy, and her only medication is a prenatal vitamin. Temperature is 37.4°C (99.3°F), pulse is 96/min, respirations are 18/min, and blood pressure is 116/80 mmHg. On physical exam, the patient appears uncomfortable, frequently shifting positions, and has marked left-sided costovertebral angle (CVA) tenderness. What additional finding, if present, would be most specific for the likely diagnosis?
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